Provider Demographics
NPI:1760043509
Name:SEWELL, SAMANTHA LYNN (CPM LM)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:LYNN
Last Name:SEWELL
Suffix:
Gender:F
Credentials:CPM LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5663 RAVENEL LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-2427
Mailing Address - Country:US
Mailing Address - Phone:703-662-3128
Mailing Address - Fax:206-984-4072
Practice Address - Street 1:5663 RAVENEL LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-2427
Practice Address - Country:US
Practice Address - Phone:703-662-3128
Practice Address - Fax:206-984-4072
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129-000145176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0129-000145OtherVIRGINIA BOARD OF MEDICINE
19060002OtherNORTH AMERICAN REGISTRY OF MIDWIVES